Safety And Necessity Of Thermal Esophageal Probes During Radiofrequency Ablation For The Treatment Of Atrial Fibrillation.

BACKGROUND Radiofrequency ablation is extensively used to achieve pulmonary veins isolation for the cure of atrial fibrillation. Luminal esophageal temperature can be monitored by means of suitable probes to prevent the onset of lesions. OBJECTIVE To compute the thermal field generated by the ablation, to investigate the interaction between the electromagnetic field and the probe sensors, and to provide a safe interpretation of the temperature detected by the probe, supported by clinical data. METHODS A mathematical model is formulated and the thermal and electromagnetic fields are computed. Experiments have been performed to assess the the influence of the ablator on the probe sensors. Clinical data have been collected during RF isolation of pulmonary veins in patients with atrial fibrillation. RESULTS The direct interaction between the radiofrequency source and the probe sensors is found to be negligible. Numerical simulations show that the outer esophageal wall can be much warmer than the lumen. Theoretical heating curves are compared with the clinical data selecting the maximal slope as the reference quantity. The clinical values range between 0.01°C/s and 0.15°C/s agree with the computed predictions and demonstrate that reducing the esophagus-atrium distance by 1mm causes a slope increase of 0.06°C/s. CONCLUSION The use of esophageal thermal probes is absolutely safe and necessary in order to prevent the occurrence of thermal lesions. The model is reliable, and describes effectively the generated thermal field. The external esophageal temperature can be considerably higher than the luminal one.